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Selexipag in the management of pulmonary arterial hypertension: an update

Authors Coghlan JG, Picken C, Clapp LH

Received 27 February 2019

Accepted for publication 2 July 2019

Published 6 August 2019 Volume 2019:11 Pages 55—64

DOI https://doi.org/10.2147/DHPS.S181313

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Colin Mak

Peer reviewer comments 2

Editor who approved publication: Professor Rajender Aparasu


J Gerry Coghlan,1 Christina Picken,2 Lucie H Clapp2

1Department of Cardiology, Royal Free Hospital, London NW3 2QG, UK; 2Institute of Cardiovascular Sciences, University College London, London WC1E 6JF, UK

Abstract: Selexipag is a compound that was designed to overcome the issues associated with oral administration of prostanoid compounds, beraprost and treprostinil in the treatment of pulmonary hypertension (PAH). As a selective IP agonist, it was designed to avoid the off-target prostanoid effects especially in the gastrointestinal system. To place this compound in context, this paper briefly reviews the efficacy, tolerability, and safety of subcutaneous, inhaled, and oral prostanoid preparations and comparesthemto selexipag. Selexipag is the first agent targeting a prostanoid receptor where a reduction in the primary efficacy morbidity/mortality composite end-point has been demonstrated. While safety outcomes favor selexipag over placebo, tolerability issues remain. Efficacy in terms of improvement in effort tolerance, hemodynamic and mortality benefit is less than seen with IV therapy. This is the first prostanoid demonstrated in a clinical trial to have added benefit in those on background double combination therapy and the first non IV prostanoid to demonstrate outcome benefit in the connective tissue disease (CTD) population in a randomized controlled trial.

Keywords: prostacyclin, prostaglandin, safety, tolerability, adverse events, efficacy


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